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Cham-of Custody Number <br /> SECOR Chain-of Custody Record 10CHAI <br /> Field Office 077 0 Additional documents are attached, and are a part of this RArd <br /> Address 301 Job Name 1 mE n I L. L" dC&hYL)_ _. <br /> hk� CtWs . CA Location <br /> 4x&fffi-Ri% CA <br /> Pro)ect#(077. Task # Analysis Request <br /> Project Manager_. 4?0 W& <br /> Laboratory Fk+CF_LCfIS � o y <br /> Turnaround Time S co z �n �,�n <br /> GI N 0 <br /> ❑'p d m c, o� m O <br /> �j 5? x m O Ca L) m� a 0 U <br /> Sampler's Name v m 0 0.0 O N 0 0 0 o y a°Y ° <br /> coUd <br /> Samplers Signature -� 0 � °' 'W 0 y <br /> T- T r T o a m �� E�, N o m N o f Comments/ 73 <br /> s am �c CL Quo �w 7tc(n WCO a( �r- a2 i' z <br /> Sample ID Date Time Matrix Instructions <br /> r 32ow [) 3 <br /> 3� d 010 , 3 <br /> MW-9 10, - <br /> �. 1600 1 1 1 U6CA 01 0 3 Co <br /> 10 D <br /> - 3 -I1 <br /> W_If 1735 0 a <br /> GV 0 0 0C,A� : <br /> Special Instructions/Comments Relinqh d Receiv by Sample Receipt <br /> ' Sign Sign Total no of containers <br /> ( " Print Pnn# Chain of custody seals <br /> Company Company Rec'd in good condition/cold <br /> DpD i 3 o Time t 3 O Date O Time t 3 . Yo Dated Conforms to record <br /> Relinquished by Received by Client <br /> tP Sign Sign <br /> Print Print Client Contact - W� <br /> Company Company <br /> Time Date Time Date Clien# Phone L 86l"O <br /> SECaR CU57AEC Rav 2/99 pp <br /> Date g / /g _ / 00 Page� of L <br />